Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 6, December 2019, pages 350-357

Practical Risk Stratification Score for Prediction of Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction

Figure 2. Comparison of area under receiver operating characteristic curve (AuROC) between new CCIT score and the Mehran risk score (MRS) in discriminating CIN cases. CCIT: Central Chest Institute of Thailand; CIN: contrast-induced nephropathy.

**Table 1.** Clinical Characteristics
Clinical characteristics	CIN (n = 43)	Without CIN (n = 174)	OR	P value	AuROC (95% CI)
CIN: contrast-induced nephropathy; SD: standard deviation; OR: odds ratio; AuROC: area under the receiver operating characteristic curve; MI: myocardial infarction; TIA: transient ischemic attack; BSA: body surface area; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; ECG: electrocardiogram; eGFR: estimated glomerular filtration rate; LDL: low-density lipoprotein; HDL: high-density lipoprotein; NA: not applicable.
Age, years (mean ± SD)	66.4 ± 12.3	59.6 ± 12.0	1.05	0.001	0.67 (0.57 - 0.76)
Male	29 (67.4)	129 (74.1)	0.72	0.378	0.46 (0.40 - 0.53)
BSA, m² (mean ± SD)	1.68 ± 0.18	1.72 ± 0.18	0.24	0.134	0.43 (0.34 - 0.53)
Hypertension	20 (46.5)	71 (40.8)	1.26	0.498	0.53 (0.46 - 0.60)
Diabetes mellitus	11 (25.6)	45 (25.9)	0.99	0.970	0.50 (0.43 - 0.57)
Hypercholesterolemia	18 (41.9)	75 (43.1)	0.95	0.883	0.49 (0.42 - 0.56)
Previous MI	0 (0.0)	6 (3.5)	NA	0.601	0.48 (0.42 - 0.55)
Previous stroke or TIA	1 (2.3)	3 (1.7)	1.36	0.794	0.50 (0.43 - 0.57)
Anemia	17 (39.5)	39 (22.4)	2.26	0.024	0.59 (0.52 - 0.65)
Smoking	18 (41.9)	85 (48.9)	0.75	0.412	0.47 (0.40 - 0.53)
Alcohol	3 (7.0)	20 (11.5)	0.58	0.394	0.48 (0.41 - 0.55)
Prior medication
ACEI or ARB	2 (4.7)	19 (10.9)	0.40	0.228	0.47 (0.40 - 0.54)
Aspirin	2 (4.7)	8 (4.6)	1.01	0.988	0.50 (0.43 - 0.57)
Metformin	5 (11.6)	22 (12.6)	0.91	0.857	0.49 (0.42 - 0.56)
Statins	9 (20.9)	32 (18.4)	1.17	0.703	0.51 (0.44 - 0.58)
Clinical parameters at presentation
SBP, mm Hg (mean ± SD)	103.3 ± 30.9	124.1 ± 27.5	0.97	< 0.001	0.31 (0.21 - 0.41)
DBP, mm Hg (mean ± SD)	60.7 ± 19.1	74.4 ± 16.3	0.95	< 0.001	0.30 (0.20 - 0.40)
HR, bpm (mean ± SD)	90.7 ± 25.3	81.2 ± 17.4	1.03	0.005	0.64 (0.53 - 0.75)
Heart failure	22 (51.2)	18 (10.3)	9.08	< 0.001	0.70 (0.64 - 0.76)
Wall of infarction from ECG
Inferior wall	18 (41.9)	80 (46.0)	1.00	0.193	-
Anterior wall	25 (58.1)	83 (47.7)	1.33
Other	0	11 (6.3)	-
Ejection fraction
< 40%	30 (69.8)	39 (22.4)	7.99	< 0.001	0.74 (0.67 - 0.79)
≥ 40%	13 (30.2)	135 (77.6)
Laboratory values
Creatinine, mg/dL (mean ± SD)	1.2 ± 0.6	1.0 ± 0.5	1.61	0.103	0.57 (0.46 - 0.67)
eGFR, mL/min/1.73 m² (mean ± SD)	68.3 ± 26.7	81.3 ± 25.5	0.98	0.004	0.35 (0.26 - 0.45)
Hematocrit, % (mean ± SD)	38.6 ± 7.2	41.3 ± 5.6	0.93	0.010	0.38 (0.28 - 0.48)
Cholesterol, g/dL (mean ± SD)	224.6 ± 75.1	195.0 ± 49.6	1.00	0.004	0.62 (0.52 - 0.72)
LDL, mg/dL (mean ± SD)	151.7 ± 56.0	127.7 ± 40.8	1.01	0.002	0.62 (0.52 - 0.73)
Triglyceride, mg/dL (mean ± SD)	153.5 ± 98.9	145.2 ± 72.3	1.00	0.532	0.50 (0.40 - 0.60)
HDL, mg/dL (mean ± SD)	46.4 ± 12.0	43.5 ± 11.3	1.02	0.146	0.61 (0.52 - 0.70)

Table 1. Clinical Characteristics

Clinical characteristics

CIN (n = 43)

Without CIN (n = 174)

P value

AuROC (95% CI)

N (%)

CIN: contrast-induced nephropathy; SD: standard deviation; OR: odds ratio; AuROC: area under the receiver operating characteristic curve; MI: myocardial infarction; TIA: transient ischemic attack; BSA: body surface area; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; ECG: electrocardiogram; eGFR: estimated glomerular filtration rate; LDL: low-density lipoprotein; HDL: high-density lipoprotein; NA: not applicable.

Age, years (mean ± SD)

66.4 ± 12.3

59.6 ± 12.0

1.05

0.001

0.67 (0.57 - 0.76)

Male

29 (67.4)

129 (74.1)

0.72

0.378

0.46 (0.40 - 0.53)

BSA, m² (mean ± SD)

1.68 ± 0.18

1.72 ± 0.18

0.24

0.134

0.43 (0.34 - 0.53)

Hypertension

20 (46.5)

71 (40.8)

1.26

0.498

0.53 (0.46 - 0.60)

Diabetes mellitus

11 (25.6)

45 (25.9)

0.99

0.970

0.50 (0.43 - 0.57)

Hypercholesterolemia

18 (41.9)

75 (43.1)

0.95

0.883

0.49 (0.42 - 0.56)

Previous MI

0 (0.0)

6 (3.5)

0.601

0.48 (0.42 - 0.55)

Previous stroke or TIA

1 (2.3)

3 (1.7)

1.36

0.794

0.50 (0.43 - 0.57)

Anemia

17 (39.5)

39 (22.4)

2.26

0.024

0.59 (0.52 - 0.65)

Smoking

18 (41.9)

85 (48.9)

0.75

0.412

0.47 (0.40 - 0.53)

Alcohol

3 (7.0)

20 (11.5)

0.58

0.394

0.48 (0.41 - 0.55)

Prior medication

ACEI or ARB

2 (4.7)

19 (10.9)

0.40

0.228

0.47 (0.40 - 0.54)

Aspirin

2 (4.7)

8 (4.6)

1.01

0.988

0.50 (0.43 - 0.57)

Metformin

5 (11.6)

22 (12.6)

0.91

0.857

0.49 (0.42 - 0.56)

Statins

9 (20.9)

32 (18.4)

1.17

0.703

0.51 (0.44 - 0.58)

Clinical parameters at presentation

SBP, mm Hg (mean ± SD)

103.3 ± 30.9

124.1 ± 27.5

0.97

< 0.001

0.31 (0.21 - 0.41)

DBP, mm Hg (mean ± SD)

60.7 ± 19.1

74.4 ± 16.3

0.95

< 0.001

0.30 (0.20 - 0.40)

HR, bpm (mean ± SD)

90.7 ± 25.3

81.2 ± 17.4

1.03

0.005

0.64 (0.53 - 0.75)

Heart failure

22 (51.2)

18 (10.3)

9.08

< 0.001

0.70 (0.64 - 0.76)

Wall of infarction from ECG

Inferior wall

18 (41.9)

80 (46.0)

1.00

0.193

Anterior wall

25 (58.1)

83 (47.7)

1.33

Other

11 (6.3)

Ejection fraction

< 40%

30 (69.8)

39 (22.4)

7.99

< 0.001

0.74 (0.67 - 0.79)

≥ 40%

13 (30.2)

135 (77.6)

Laboratory values

Creatinine, mg/dL (mean ± SD)

1.2 ± 0.6

1.0 ± 0.5

1.61

0.103

0.57 (0.46 - 0.67)

eGFR, mL/min/1.73 m² (mean ± SD)

68.3 ± 26.7

81.3 ± 25.5

0.98

0.004

0.35 (0.26 - 0.45)

Hematocrit, % (mean ± SD)

38.6 ± 7.2

41.3 ± 5.6

0.93

0.010

0.38 (0.28 - 0.48)

Cholesterol, g/dL (mean ± SD)

224.6 ± 75.1

195.0 ± 49.6

1.00

0.004

0.62 (0.52 - 0.72)

LDL, mg/dL (mean ± SD)

151.7 ± 56.0

127.7 ± 40.8

1.01

0.002

0.62 (0.52 - 0.73)

Triglyceride, mg/dL (mean ± SD)

153.5 ± 98.9

145.2 ± 72.3

1.00

0.532

0.50 (0.40 - 0.60)

HDL, mg/dL (mean ± SD)

46.4 ± 12.0

43.5 ± 11.3

1.02

0.146

0.61 (0.52 - 0.70)

**Table 2.** Operative Procedure and Findings
Procedural findings	CIN (n = 43)	Without CIN (n = 174)	OR	P value	AuROC (95% CI)
CIN: contrast-induced nephropathy; OR: odds ratio; AuROC: area under the receiver operating characteristic curve; CI: confidence interval; IABP: intra-aortic balloon pump; PCI: percutaneous coronary intervention; SD: standard deviation.
Angiographic findings
Single-vessel disease	9 (20.9)	64 (36.8)	1.00	Ref	-
Double-vessel disease	7 (16.3)	56 (32.2)	0.89	0.826	-
Triple-vessel disease	27 (62.8)	54 (31.0)	3.56	0.003	-
PCI treated
Culprit vessel PCI	41 (95.3)	165 (94.8)	1.00	0.889	0.50 (0.43 - 0.57)
Multivessel PCI	2 (4.7)	9 (5.2)	0.89
Contrast type
Ioversol	1 (2.3)	10 (5.8)	1.00	0.376	0.52 (0.45 - 0.58)
Iopromide-370	42 (97.7)	164 (94.3)	2.56
Contrast volume, mL (mean ± SD)	115.6 ± 45.9	112.2 ± 39.7	1.00	0.625	0.51 (0.41 - 0.61)
Hypotension	24 (55.8)	22 (12.6)	8.72	< 0.001	0.72 (0.65 - 0.77)
Use of IABP	19 (44.2)	8 (4.6)	16.4	< 0.001	0.70 (0.63 - 0.76)

Table 2. Operative Procedure and Findings

Procedural findings

CIN (n = 43)

Without CIN (n = 174)

P value

AuROC (95% CI)

N (%)

CIN: contrast-induced nephropathy; OR: odds ratio; AuROC: area under the receiver operating characteristic curve; CI: confidence interval; IABP: intra-aortic balloon pump; PCI: percutaneous coronary intervention; SD: standard deviation.

Angiographic findings

Single-vessel disease

9 (20.9)

64 (36.8)

1.00

Ref

Double-vessel disease

7 (16.3)

56 (32.2)

0.89

0.826

Triple-vessel disease

27 (62.8)

54 (31.0)

3.56

0.003

PCI treated

Culprit vessel PCI

41 (95.3)

165 (94.8)

1.00

0.889

0.50 (0.43 - 0.57)

Multivessel PCI

2 (4.7)

9 (5.2)

0.89

Contrast type

Ioversol

1 (2.3)

10 (5.8)

1.00

0.376

0.52 (0.45 - 0.58)

Iopromide-370

42 (97.7)

164 (94.3)

2.56

Contrast volume, mL (mean ± SD)

115.6 ± 45.9

112.2 ± 39.7

1.00

0.625

0.51 (0.41 - 0.61)

Hypotension

24 (55.8)

22 (12.6)

8.72

< 0.001

0.72 (0.65 - 0.77)

Use of IABP

19 (44.2)

8 (4.6)

16.4

< 0.001

0.70 (0.63 - 0.76)

**Table 3.** Multivariable Logistic Regression Analysis
Variables	OR	95% CI	P value
OR: odds ratio; CI: confidence interval; ECG: electrocardiogram; IABP: intra-aortic balloon pump; CHF: congestive heart failure; eGFR: estimated glomerular filtration rate; TVD: triple-vessel disease; PCI: percutaneous coronary intervention.
Age > 75 years	3.40	1.01 - 11.45	0.048
Diabetes mellitus	0.85	0.32 - 2.28	0.748
Anemia	1.30	0.46 - 3.73	0.621
Hypotension	2.85	0.77 - 10.58	0.117
CHF	1.04	0.28 - 3.94	0.949
Anterior wall infarction from ECG	2.49	0.99 - 6.24	0.052
Ejection fraction < 40%	4.87	1.92 - 12.35	0.001
eGFR < 60 mL/min/1.73 m²	0.54	0.18 - 1.60	0.263
Triple-vessel disease	2.48	1.02 - 6.05	0.046
PCI treated	0.19	0.02 - 2.08	0.175
Iopromide 370 (contrast media)	8.82	0.62 - 124.96	0.107
Contrast media volume (every 100 mL increment)	1.00	0.99 - 1.01	0.940
Use of IABP	4.55	0.87 - 23.68	0.072

Table 3. Multivariable Logistic Regression Analysis

Variables

95% CI

P value

OR: odds ratio; CI: confidence interval; ECG: electrocardiogram; IABP: intra-aortic balloon pump; CHF: congestive heart failure; eGFR: estimated glomerular filtration rate; TVD: triple-vessel disease; PCI: percutaneous coronary intervention.

Age > 75 years

3.40

1.01 - 11.45

0.048

Diabetes mellitus

0.85

0.32 - 2.28

0.748

Anemia

1.30

0.46 - 3.73

0.621

Hypotension

2.85

0.77 - 10.58

0.117

CHF

1.04

0.28 - 3.94

0.949

Anterior wall infarction from ECG

2.49

0.99 - 6.24

0.052

Ejection fraction < 40%

4.87

1.92 - 12.35

0.001

eGFR < 60 mL/min/1.73 m²

0.54

0.18 - 1.60

0.263

Triple-vessel disease

2.48

1.02 - 6.05

0.046

PCI treated

0.19

0.02 - 2.08

0.175

Iopromide 370 (contrast media)

8.82

0.62 - 124.96

0.107

Contrast media volume (every 100 mL increment)

1.00

0.99 - 1.01

0.940

Use of IABP

4.55

0.87 - 23.68

0.072

**Table 4.** Best Multivariable Clinical Predictors, OR, 95% CI, Logistic Regression Beta Coefficient (β) and Assigned Item Scores
Predictors	OR	95% CI	P value	β	Score
OR: odds ratio; CI: confidence interval; IABP: intra-aortic balloon pump.
Ejection fraction < 40%	4.47	1.94 - 10.35	0.001	1.50	2
Triple-vessel disease	2.80	1.25 - 6.27	0.012	1.03	1
Use of IABP	6.58	2.39 - 18.13	< 0.001	1.88	3
Constant	0.05	0.02 - 0.11		-2.91

Table 4. Best Multivariable Clinical Predictors, OR, 95% CI, Logistic Regression Beta Coefficient (β) and Assigned Item Scores

Predictors

95% CI

P value

Score

OR: odds ratio; CI: confidence interval; IABP: intra-aortic balloon pump.

Ejection fraction < 40%

4.47

1.94 - 10.35

0.001

1.50

Triple-vessel disease

2.80

1.25 - 6.27

0.012

1.03

Use of IABP

6.58

2.39 - 18.13

< 0.001

1.88

Constant

0.05

0.02 - 0.11

-2.91

**Table 5.** Distribution of Contrast-Induced Nephropathy Cases Across Two Different Categories of CCIT Score (Low Risk and High Risk for CIN)
Risk categories	Score	CIN (n = 43)	Without CIN (n = 174)	PPV	95% CI	P value
CCIT: Central Chest Institute of Thailand; CIN: contrast-induced nephropathy; PPV: positive predictive value; CI: confidence interval; SE: standard error.
Low	0 - 2	17	39.5	154	88.5	9.9	5.4 - 14.4	< 0.001
High	3 - 6	26	60.5	20	11.5	56.5	42.2 - 70.8	< 0.001
Mean ± SE		3.3	± 0.3	0.9	± 0.1			< 0.001

Table 5. Distribution of Contrast-Induced Nephropathy Cases Across Two Different Categories of CCIT Score (Low Risk and High Risk for CIN)

Risk categories

Score

CIN (n = 43)

Without CIN (n = 174)

PPV

95% CI

P value

N (%)

CCIT: Central Chest Institute of Thailand; CIN: contrast-induced nephropathy; PPV: positive predictive value; CI: confidence interval; SE: standard error.

Low

0 - 2

39.5

154

88.5

9.9

5.4 - 14.4

< 0.001

High

3 - 6

60.5

11.5

56.5

42.2 - 70.8

< 0.001

Mean ± SE

3.3

± 0.3

0.9

± 0.1

< 0.001